I make quite a few full dentures. I do this mostly in cases where
people come in with an old one that needs to be replaced. There are
also cases in which people present with teeth in such bad condition
that there is literally no other affordable alternative. However, many
young people come to my office with numerous teeth that have what they
believe are non-repairable cavities, or they may not like the appearance
of their teeth because they are crooked. They expect the denture will
be a simple way to correct all their problems.

Many of these people have avoided going to the dentist because they
are afraid of what the dentist will think, or afraid of what will happen
to them once they get there. Let me make four things very
clear.

1. We see people with very bad teeth ALL THE TIME.
At least half of all our patients come to the dentist the first
time only because they are in so much pain that they can't stand
it anymore! They become good dental patients only because of their
first few bad toothaches. You are not alone in having this
problem!

2. Your fear of the pain is WAY out of proportion to
the actual pain you will feel when we work on you.
Do you remember how big your dad and mom looked to you when you
were a child? When you finally grew up, they didn't look so
big anymore. Your memory of the pain involved in seeing a
dentist is like that too. Once you actually see it with grown
up eyes, it doesn't look so big and bad anymore. Many of our
very best regular patients started out just like you. They sometimes
come in just to say hi even when they don't have a problem because
the staff is friendly, and the atmosphere makes them feel comfortable.

3. Full dentures are a last resort! If
you are used to having even diseased or ugly teeth, you cannot even
imagine how disappointed you may be with full dentures.
Dentures are, in fact, a sort of myth made of plastic!
(Read on and you will see why.) I've been making them since
1978. I've seen it all!

4.
You do not naturally lose your teeth when you get old.
This is a picture of a 73 year old man who simply brushed daily
and used toothpicks to clean between his teeth all his life.
He didn't eat much sugar except when he was very young (which accounts
for the one visible filling you see on the upper left back tooth).
With a little care, anyone can keep their teeth all their life!

Click
here to read an
exchange of e-mails between me and a patient who got
a denture and found she could not wear it. These situations
happen all the time and can be downright tragic.

Things your mother never told you--(about her false teeth)!

1. Having full dentures
is like having fake hands. They may look like real hands, but try holding
a pen to write your name with them. False teeth are not real teeth.
People with them can barely chew their food, You can put just
15% of the pressure on false teeth as you normally use to chew your
food, before they lose the suction that keeps the top one in your mouth.
The lower ones have no suction at all and they just sit there by virtue
of their own weight, and the ability of the tongue to help them stay
put. Many people find lower dentures so cumbersome that even if the
top ones are reasonably successful, they do not wear the lowers except
when they go out in public.

2. As soon
as the natural teeth are removed, the face begins to age rapidly. When
new dentures are inserted for the first time, your facial appearance
remains the same...at first .... But as soon as you walk out the
door, the bone that held your original natural teeth begins the process
of resorption (disappearing) which begins the process of collapsing
your facial appearance.

Note:
It is helpful to see the severe boneloss that can eventually happen after the teeth
are extracted. Compare the panoramic x-ray of a
normal mouth
(seen on the x-ray page ) with that of a person who has been without
teeth (edentulous)
for a number of years (on the implant page)
and notice the amount of bone that nature can remove if the teeth
are extracted at an early age. Click on the toothless skull above
to read more about what happens to the bone once the teeth are extracted.

Note
that bone resorption can be prevented by replacing natural teeth
with dental implants soon after they
are extracted. While implants are a much more expensive
alternative than keeping the natural teeth, they are still infinitely
better than the problems associated with going without teeth
and ending up with a full denture!

Dentures accelerate the aging process of your face because
the distance between your nose and your chin begins to decrease
as soon as the natural teeth are extracted. The bone that used
to hold your top natural teeth begins to retreat up toward your nose,
and the bone that held the lower natural teeth "goes south",
allowing both the top and bottom false teeth to ride with them in the
same directions. Within a few months, your face ages several years.
As a result, the denture teeth eventually begin to disappear under your
lips while the lips themselves begin to flatten out. This process
continues for the rest of your life.

The image on the left above shows the facial appearance of
a 48 year old woman who had her teeth removed at the age of 28.
Unfortunately, she kept her same denture the full 20 years. This
allowed the distance between her nose and her chin to collapse (this
distance is called the vertical dimension). Note
the flattening or "sinking" of the lips. As the
lips flatten, they begin to develop little vertical wrinkles called
ragades, orperioral Lines
(marked in blue on the diagram on the right). The diagonal
lines marked in yellow are called the labiomental folds.
These tend to become more pronounced as the lips, no longer supported
by lower teeth and gums collapse inward, and the vertical dimension
diminishes. The lips begin to blend into the labiomental folds
bringing about the illusion that the lips are a great deal longer from
right to left than they really are. The combination of sunken
lips and pronounced labiomental fold give the mouth the appearance of
a horizontal slit rather than the full lipped appearance of a person
with natural teeth. In some people, the diagonal lines from the
corner of the nose to the corners of the lips, called the nasolabial
folds (marked in red) become much more pronounced after the
loss of the teeth adding to the appearance of rapid aging.

The
edentulous (toothless) woman shown above is 48 years old. Compare
her with this 53 year old woman who has retained all her natural
teeth. The fullness of the lips and the lack of ragades are due
to the steady presence of the natural teeth throughout her life.
The nasolabial folds become apparent mostly when she smiles. The
Labiomental folds are not apparent, due to the presence of the lower
teeth (and their supporting structures) which support the lower lip
to keep it from sinking inward. While this patient is chronologically
older than the patient above, she looks physically younger because she
kept her natural teeth.

The images above are drawn by hand, but they show the real world
effect of the loss of the teeth. The image to the left shows the
profile of a middle age woman with a full set of teeth. The center
image shows what the patient would look like immediately after the extraction
of her teeth. The image to the right shows what the patient would
look like at the same age if the teeth had been removed about ten years
before. If you have ever ridden the subway in any large city,
you have seen people with this type of deformity. They were not
born that way. They have simply lost all their teeth. Click
on the image to go to the website of the
International Congress
of Oral Implantologists
for more on this subject

Click
on the icon to the left to find out why granny never wears her lower
denture.

3. A denture is NOT forever.
As dentists, we can help prevent some of the facial aging if (and only
if) you return every 2 years for a
reline, and
every 5 to 7 years to get new dentures. If you don't wait too
long, we can usually build new dentures with "longer teeth"
(actually extra pink plastic that replaces the gums). We can also place
the teeth somewhat further forward to fill out your lips a bit. However
if you wait too long, the muscles that let you chew your food
begin to shorten to accommodate the reduced space between your nose
and chin (vertical dimension), and you will not be
able to tolerate the increase in length of the teeth that would be necessary
to restore your original vertical dimension. This is nature talking,
not the dentist who will do his best to accommodate your wishes.

A denture worn too long can really do damage to the facial appearance.
Long term wear of an old denture can force huge changes in the muscles
of the face which affect not only facial appearance, but functional
changes in the way the patient uses the jaws.
Click
here
to read about my patient Popeye. His story comes
at the end of a page written primarily for dentists, dental students
and other dental professionals. The rest of the page is full
of technical data on occlusion, the study of the
relationship between the position of the teeth, the muscles of mastication
and the corresponding position of the jaw joints. But for
readers with endurance, it will provide some insight into the secret
lives of dentists and just how complex the profession really
is.

4. Dentures must be relined every two years. This means that new
plastic must be added to the inside of your existing denture in order
to fill spaces between the denture and the gums left vacant by the receding
bone. Relines do NOT restore vertical dimension, but
they do keep the denture tight and stable. If you fail to reline the
denture the consequences are not good.

As the bone recedes and more and more space becomes vacant inside
the denture, most people will begin wearing stiff denture adhesives
to maintain the dentures in their mouths. They tend not to notice that
the teeth move around more and more while chewing food. When a denture
retains suction, but begins to move around over the bony ridge that
supports it, we say the denture has good RETENTION,
but lacks STABILITY. When the hard denture base is
in close approximation to the bone that supports it, the denture has
maximum stability, but as the distance increases, no matter what type
of goo you put under it, the teeth become less and less stable and are
much more easily dislodged by chewing food.

People become accustomed
to the gradually developing poor fit. They know that the appliance
isn't what it used to be, and they plan to get new dentures, but simple
inertia keeps them from going back to the dentist. However, if
they have waited more than two years to reline or rebuild the denture,
something unfortunate happens to the tissue that supports it.
Nature begins to build more gums between the bone and the denture
to take up the slack. At first this sounds good, but
the gum tissue that nature builds after the real teeth are gone is
soft and flabby. It's like a layer of Jell-O.
This flabby tissue adapts to the denture and provides some suction,
but it won't support any weight. In other words, the flabby new
gum tissue that forms because of an ill fitting denture will not support
a stable denture. This means that when you bite
food on the front or the side of the denture, it will displace causing
it to move around and loose suction.

The
image to the right shows an example of a very common form of flabby,
redundant tissue that forms under an ill fitting denture. It looks
like little pebbles on the roof of the mouth. This type of overgrowth
is called papillary hyperplasia. It is permanent
until it is surgically removed. Of more practical importance to
the denture's stability are the thick layers of flabby tissue that form
over the U shaped bony ridge, which is the area most responsible for
supporting the denture during chewing.

The take-home lesson here is that even a new denture built over this
flabby tissue will not fit much better than the old one.
The new denture will have the same stability problems as the
old one unless the patient goes to an oral surgeon to have the flabby
tissue removed before the new denture is made.

If you need to use more than a touch of denture adhesive to retain
your denture, then you need a reline. I have seen some very odd
things used to take up extra space inside an old denture. Some
patients use layers of tissue paper. One patient actually presented
to their dental office with a neatly trimmed slice of bologna as a makeshift "denture
liner". Using anything other than denture adhesive is a bad
idea because the denture breath gets pretty ripe!

5.
If you are a "gagger" (and have avoided seeing dentists to
avoid gagging), you can be sure that the new denture will cause you
to gag too. Probably the saddest group of people we see in this profession
are those people who hate dentists because they tend to gag when anyone
(including a dentist) puts something in their mouths. These people have
it in the back of their mind that they can just wait until their teeth
get so bad that a dentist will just put them to sleep, remove the teeth
and they will wake up with false teeth and live happily ever after.

Actually, the first part of the dream can come true. It is expensive,
but you can get your teeth pulled under general anesthesia and have
an
immediate denture inserted. It's the "happily ever after"
that doesn't pan out. Gaggers tend to go toothless a lot because the
presence of the denture in their mouths makes them feel like throwing
up all the time. They avoid eating at other people's houses, and will
wear their dentures only when absolutely necessary. The only hope these
people have is if they can afford full mouth
implants.

Click here to read an
exchange of e-mails between me and a patient who got a denture
and found she could not wear it. These situations happen all
the time and can be downright tragic.

What are the affordable alternatives to having all the teeth
removed?

1. Missing and hopeless teeth can be replaced without extracting
the good teeth. They can be replaced using
Removable partial dentures.
Partial dentures are much more comfortable and stable than full dentures.
They do not have to cover the entire roof of your mouth for stability
because they are held in by the remaining natural teeth. Even the presence
of a few natural teeth remaining on either side of the dental arch can
make it possible to wear a partial denture instead of full dentures.
The presence of any number of real teeth can reduce (though not completely
eliminate) the accelerated aging process
associated with full dentures.

This man has only 4 teeth, but his all-plastic partial is as
stable as a rock! The clasps are made of plastic and are visible
under my fingers.

2. Even if you are unhappy with the appearance of your front teeth,
it is possible to replace only the front ones with
a partial denture. If you have two front teeth that are very crooked,
it is possible to remove only these and replace them with a partial
or bridge and avoid removing all the other teeth.

Having said this, there are always people who really DO need to have
all their teeth extractedand have dentures made. These
include people with all their teeth so badly decayed that they would
all require root
canals and crowns
which can become extremely expensive, and not every patient can afford
this. They include people with terminal
gum disease which has
caused the teeth to become loose or to change their positions so badly
that repair again becomes too expensive, or likely to fail after a short
while. They also include people who have been to dentists for years
trying to save their teeth, but have finally given up and are just plain
tired of all the bother their teeth have caused them. No matter who
you are, they are your teeth, and you have a right
to have them removed if you have ultimately made up your mind to do
so. If this applies to you, I have prepared an
entire page
on the different types of dentures, and the steps involved in making
them.

Yes, this man has no teeth!
At the time of writing, he is an escaped convict.
I know you're curious. Click on his image for more.

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